Provider Demographics
NPI:1003862475
Name:CHOPDE, NITIN MOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:MOHAN
Last Name:CHOPDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2889
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-2889
Mailing Address - Country:US
Mailing Address - Phone:301-776-9000
Mailing Address - Fax:301-776-9259
Practice Address - Street 1:13976 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-776-9000
Practice Address - Fax:301-776-9259
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338011400Medicaid